1998 Volume 38 Issue 2 Pages 119-126
We examined the cases of consultation-liaison service at the department of psychiatry in our university hospital, and pointed out the present problems as follows : 1) The items listed in the consultation sheet of our department of psychiatry from other departments are not sufficient. We have no room suitable for psychiatric interview in each ward.In our hospital we have no specific department standing for psychosomatic medicine as seen in other university hospitals in Japan.2) There are still many general hospitals which have no department of psychiatry in Japan. Consultations from other general hospitals in the community are often referred to our department of psychiatry. General hospitals, especialy public ones, should open an outpatient clinic of psychiatry for at least half a day per week.3) As consultations are referred to the department of psychiatry by doctors of other fields without making an appointment, there are consultations in almost endless succession on the same day.4) The atmospheres of the ward of obstetrics and gynecology and that of pediatrics seem to be different from those of other wards. The major problems to be discussed are the pregnancy and delivery of the patients with mental disorders in the ward of obstetrics and gynecology, whereas the relationship between the pediatrician and the family of the child in the ward of pediatrics.5) The transfer of patients from other wards to the ward of psychiatry is sometimes difficult because of the opposition by psychiatric nurses. Therefore, we try to treat the patients in that ward through intensive psychiatric therapy in order not to transfer them to the ward of psychiatry.6) The patients with attempted suicide who are admitted to the ward of critical care medicine are all consulted with the department of psychiatry. Therefore, this system is more liaison than consultation service. Regarding those patients, we must assess mental disorders, re-attempted suicide, and discharge or transfer to the ward of psychiatry.7) We often see a patient with a comorbidity of mental and physical disorders, for example, schizophrenia and gastric cancer. We always have to fully understand both mental and physical conditions of that patient. It is often argued when psychotropic drugs, for example, should be restarted for the patient after the operation.8) Sometimes we are asked to treat staff and clerks of our own hospital. However, we are wondering if we should ask psychiatrists in other hospitals to see them.
